ACA Open Enrollment Looms: Is Government Ready This Time?

In this industry Q&A, one major health-care exchange contractor offers predictions for what open enrollment will look like the second time around.

Health insurance exchanges were hard pressed for any positive media coverage this time last year, due largely to hastily planned and inadequately tested websites that left consumers frustrated -- and sometimes uninsured. But as the months wore on, contractors were shuffled, leadership changed, and even the most notorious failures seemed on some kind of path to turning things around.

Enter open enrollment, which starts on Nov. 15 and spans the three months that follow. Stakeholders across the spectrum are busily preparing for the onslaught. Among them is call center operator Maximus Inc., under contract for five state exchanges -- Connecticut, Hawaii, Maryland, New York and Vermont -- the District of Columbia exchange, and as a subcontractor to General Dynamics, two of the federal government’s 17 call centers. All told, several thousand workers trained by Maximus stand ready to help consumers answer questions and get covered.

And there’s reason to expect call centers will be busy. During the initial enrollment period, these centers fielded 4.8 million calls. Call volume and call length understandably increased as the enrollment window drew to a close.
Government Technology talked to Maximus' president of health operations Eric Rubin, pictured at left, to get his take on what to expect the second time around.

Government Technology: How long have you been working with the public sector on the Affordable Care Act (ACA)?

Eric Rubin: Just about every one of these contracts were awarded the spring or summer before the ACA rolled out. We had been advising a number of states on the implications of the ACA and what they should consider as far as the capabilities that their contact centers should have approximately 18 months to two years before the ACA rolled out.

GT: The challenges with the initial rollout are well-documented, especially as they relate to technology. What did that look like from Maximus' point of view?
Rubin: Most of the calls that we initially got were around people trying to fill out applications online, since this was set up as a paperless process. So then people were saying, 'If I can't get online and fill out an application, how else can I fill out an application?' So we either provided them access to the navigators and the assisters or other community-based organizations that they could go and talk to 1-on-1, or, in other cases, we would literally fill out an application for them on the phone.

GT: So the enrollment process transitioned completely to a paper process when people ran into road blocks online?

Rubin: That really varied state to state. In some states we were able to help people navigate what the issues were. In some situations, where people were looking on the screen and it was saying to them that their application wasn't complete, we were looking at it within the system, and their application really was complete. So we were then able to intercede on the back end, working with our state partners, to move those applications along in the process and get them over to the health plan that they selected.

GT:Going into open enrollment this year, what kind of process do you expect? What will be different?

Rubin: All the states and the federal government have been working hard to address those specific areas that really impacted the customer experience, so I think there's going to be a better customer experience overall, although there will be the inevitable hiccups along the way.

This year we will see a difference in the populations coming in: We've got those that are already enrolled -- we're calling them the second generation of enrollees. They’re already enrolled, but they found out there's a difference in health plan costs. There are also going to be tax forms coming out for the first time for anyone who was enrolled, and lots of the questions will be about what does this tax form mean, how does it impact me. We'll also have those people who really stood on the sidelines or were just harder to reach, and our partners are preparing more targeted outreach activities than they even did last year.

Last year was a year of experimentation. People found some things that really worked, and they're really going to use those to target these individuals. Those people will probably have a lower health literacy than people who came in last year so there's going to be a lot more education as to what their benefits really are, how the process works, how they actually select a plan and then what happens downstream.

GT:Overall, would you say that the technology is in place for a smoother process this year?
Rubin: I know our clients have been working hard at getting the technology in place, so I think their expectation is that this hard work will pay off in a better consumer experience. I think time will tell as the technology rolls out.

GT:What kinds of things should health exchange teams be doing in these last few weeks before open enrollment to be as prepared as they can?

Rubin: With all of our clients, we sat down and did lessons learned, and from those lessons learned, we developed much more specific training for the people who man the contact centers. We also looked at the populations that are coming in. In some cases, we are forming specific teams to help specific populations. The District of Columbia enrolls all the congressional staff, so in that case, we have specialists who can address that segment of the population's needs, which are very different than the average American that is enrolling. We spent the summer training people on the nuances of the law and focusing on those specific areas that will make for a better consumer experience. We really stressed with people that personal outreach, that kind of empathy to maximize the enrollment this year.

Editor's Note: Responses have been edited for length.

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Government Technology editor Noelle Knell has more than 15 years of writing and editing experience, covering public projects, transportation, business and technology. A California native, she has worked in both state and local government, and is a graduate of the University of California, Davis, with majors in political science and American history. She can be reached via email and on Twitter.